儿童甲型H1N1流行性感冒相关性脑病死亡危险因素分析  

Analysis of risk factors for death from influenza A(H1N1)-associated encephalopathy in children

作　　者：李珊珊 胡丹丹 LI Shanshan;HU Dandan(Emergency Department,Shenzhen Children's Hospital,Shenzhen 518038,Guangdong,China;Child Healthcare Department,Women and Children's Medical Center Affiliated to Guangzhou Medical University,Guangzhou 510180,Guangdong,China)

机构地区：[1]深圳市儿童医院急诊科,广东深圳518038 [2]广州医科大学附属妇女儿童医疗中心儿童保健科,广东广州510180

出　　处：《临床儿科杂志》2025年第3期177-183,190,共8页Journal of Clinical Pediatrics

基　　金：广州市科技计划项目(No.202201020648);广州市市校院联合基金项目(No.202201020620);广州市重点研发计划项目(No.202206010060)。

摘　　要：目的寻找儿童甲型H1N1流行性感冒(简称流感)相关性脑病(IAE)死亡的危险因素,为临床早期诊断及干预提供依据。方法回顾性分析2014年1月至2020年12月医院收治的甲型H1N1 IAE患儿的临床资料,按预后分为存活组与死亡组。通过二分类logistic回归分析与甲型H1N1 IAE患儿死亡相关的危险因素。结果共纳入甲型H1N1 IAE 59例患儿,男39例、女20例,中位年龄为42(21~73)个月,<5岁患儿占66.1%(39/59)。出现神经系统症状与发热相距时间中位数为1(0.5~2)天。33例(55.9%)患儿并发重症肺炎、呼吸衰竭,其中1例并发塑型性支气管炎。58例患儿使用奥司他韦抗流感治疗,发病至使用抗流感药物中位时间为2(1~4)天。好转出院48例,死亡11例(18.6%),入院至死亡中位时间为3(1~5)天。与存活组相比,死亡组意识障碍、呼吸衰竭、脑疝发生率以及需要机械通气治疗的比例更高,中性粒细胞计数更高,降钙素原、血糖、天门冬氨酸氨基转移酶、丙氨酸氨基转移酶、乳酸脱氢酶水平更高,凝血酶原时间更长,头颅CT异常比例更高,单核细胞计数更低,差异均有统计学意义(P<0.05)。二分类logistic回归分析结果发现,中性粒细胞计数以及乳酸脱氢酶水平升高可能与甲型H1N1 IAE患儿死亡发生相关(P<0.05)。结论对于甲型H1N1 IAE患儿,如中性粒细胞计数和乳酸脱氢酶水平升高时,发生死亡的风险可能增加,需引起重视。Objective To explore the risk factors of death from influenza A(H1N1)-associated encephalopathy(IAE)in children,and to provide evidence for early clinical diagnosis and intervention.Methods The clinical data of children with H 1 N 1 IAE admitted to the hospital from January 2014 to December 2020 were retrospectively analyzed,and they were divided into the survival group and the death group according to prognosis.The risk factors associated with death in children with H 1 N 1 IAE were analyzed by binary logistic regression.Results A total of 59 children(39 boys and 20 girls)with H 1 N 1 IAE were included.The median age was 42(21-73)months,and 66.1%(39/59)of the children were<5 years old.The median time between the onset of neurological symptoms and fever was 1(0.5-2)days.Thirty-three patients(55.9%)had severe pneumonia and respiratory failure,and 1 of them had plastic bronchitis.Fifty-eight children were treated with oseltamivir.The median time from onset to use of anti-influenza drugs was 2(1-4)days.Forty-eight patients were discharged from hospital with improvement and 11 died(18.6%).The median time from admission to death was 3(1-5)days.Compared with the survival group,the death group presented higher incidences of consciousness disorder,respiratory failure,and brain herniation,a greater proportion of cases requiring mechanical ventilation treatment,a higher neutrophil count,elevated levels of procalcitonin,blood glucose,aspartate aminotransferase,alanine aminotransferase,and lactate dehydrogenase,a longer prothrombin time,a higher ratio of abnormal head CT findings,and a lower monocyte count.All the differences were statistically significant(P<0.05).The results of binary logistic regression analysis revealed that elevated neutrophil count and lactate dehydrogenase levels might be associated with the occurrence of death in children with H 1 N 1 IAE(P<0.05).Conclusions For children with H 1 N 1 IAE,the risk of death may increase with elevated neutrophil counts and lactate dehydrogenase levels.

关 键 词：甲型H1N1流感 脑病 死亡 危险因素 儿童 

分 类 号：R725.1[医药卫生—儿科]